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Plan managers need to adapt requirements

TAMPA, Fla. – Craig Kraft has his own beef with the health plan managers that are increasingly overseeing Medicaid programs in states like Florida.

Kraft, the seating coordinator at the Shriners Hospitals for Children in Tampa says these managers are quick to follow Medicare’s lead with restrictive policies like the in-the-home rule, but not constructive policies like requiring that an ATP be involved in the provision of complex rehab wheelchairs.

“It’d be nice if it went both ways,” he said.

Going back all the way to 2008, CMS began requiring that HME companies have an ATP on staff to provide Group 3 complex rehab wheelchairs.

Because health plan managers often don’t have an ATP requirement and they limit referrals to a select group of HME companies that don’t always specialize in complex rehab, Kraft says it’s sometimes difficult to get his patients the wheelchairs they need.

“I don’t begrudge these companies a referral and the success in gaining a contract, but there have to be standards that need to be met,” he said.

Due to his growing concerns, Kraft has developed a set of minimum requirements that he’d like the HME companies he works with to meet, including the ability to deliver a wheelchair, with all the parts prescribed and with a mid-line sitting alignment, in one appointment.

“Unfortunately, we’ve found that 50% of deliveries don’t meet this standard,” he said.

With layoffs and tighter budgets, Kraft says he has had to rely on the work of HME companies more and more.

“The simple things that we used to be able to do, like point-of-care adjustments, we’re less able to do,” he said. “Now it’s, ‘Here’s your prescription; go back to your dealer.’”